How to use revenue codes with trauma patients

APCs Insider, April 12, 2004

QUESTION: I need to understand how to correctly use revenue codes in the 068X series for trauma. I think we should continue to use 450 for the actual ED services and then also bill a trauma-activation fee under the 068X. Is this correct? If so, do I set up different activation fees based on the acuity of the service provided and bill under 0681, or 0682, or 0683, etc.? Or do we use only one 068X with the last digit matching the trauma certification of our facility (e.g., Level 1 Trauma Center would only bill 0681, Level 2 Trauma Center would only bill 0682, etc.). I understand that this is a packaged revenue code, but I would like the bill to demonstrate the cost involved in these resource-intensive cases.

ANSWER:Medicare Intermediary Manual Transmittal 1875 (CR 2456), issued February 7, 2003, updated section 3604, Review of Form HCFA-1450 for Inpatient and Outpatient Bills, to include new revenue codes (RC) approved by the National Uniform Billing Committee in Form Locator 42. One of the codes is RC 068X, Trauma Response, which became effective October 1, 2002.

RC 068X is packaged under the hospital outpatient prospective payment system (OPPS). Payment for RC 068X under the hospital inpatient prospective payment system (IPPS) is included in the DRG payment. Institutions that report RCs and submit claims to fiscal intermediaries that are not paid under the hospital OPPS or IPPS would be paid for RC 068X under existing applicable payment methodologies.

You are correct that you should continue to use 450 for the actual ED services and also bill a trauma-activation fee under 068X. This revenue code is for reporting the trauma-activation costs only. It is not a replacement or substitute for the ED visit fee. If trauma activation occurs, you would normally report revenue codes 45X and 68X. Note that it is not appropriate to use the ED visit levels 99281-99285 with RC 068X.

The established trauma revenue codes are 681 for Level I, 682 for Level II, 683 for Level III, and 684 for Level IV trauma centers/hospitals. There is a 689, but it has not been defined. These codes are only to be used by trauma hospitals designated/categorized by a local or state agency with the legal authority to do so or verified by the American College of Surgeons (ACS). Therefore, you should not use only one 068x with the last digit matching the trauma certification of your facility.

Only patients for whom there has been prehospital notification, who meet either local, state, or ACS field-triage criteria, or are delivered by interhospital transfers, and are given the appropriate team response, can have the activation-fee charge. Patients who are "drive-by" or arrive without notification cannot be charged for activation, but can be classified as trauma under "trauma" for statistical and follow-up purposes.

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